Bivalirudin versus heparin in patients undergoing percutaneous coronary intervention in acute coronary syndromes
Comparative review published in Critical Pathways in Cardiology (2025)
Abstract
INTRODUCTION: Data on outcomes between unfractionated heparin and bivalirudin anticoagulation during percutaneous coronary intervention (PCI) in acute coronary syndromes remain inconclusive. We aimed to systematically analyze PCI outcomes by comparing unfractionated heparin and bivalirudin. METHODS: We systematically searched Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception in 1966 through January 2024 for studies evaluating PCI outcomes comparing unfractionated heparin and bivalirudin. Two investigators independently reviewed the data. Conflicts were resolved through consensus. Random-effects meta-analyses were used. RESULTS: A total of 10 prospective trials were identified that enrolled 42,253 individuals who presented with an acute coronary syndrome. Our analysis found that heparin when compared to bivalirudin was associated with an increased risk of trial-based definition of major bleeding [relative risk (RR): 1.68, 95% confidence interval (CI): 1.29-2.20], nonaccess site complications (RR: 4.6, 95% CI: 1.75-12.09), thrombolysis in myocardial infarction major bleeding (RR: 1.70, 95% CI: 1.20-2.41), major bleeding risks (RR: 1.87, 95% CI: 1.49-2.36), cardiovascular disease death (RR: 1.26, 95% CI: 1.02-1.57), and thrombocytopenia (RR: 1.67, 95% CI: 1.07-2.62). There were no statistically significant differences between heparin and bivalirudin for all-cause mortality, major adverse cardiovascular event, stroke, reinfarction, target vessel revascularization, and acute or stent thrombosis. CONCLUSIONS: The present meta-analysis demonstrates bivalirudin reduces major bleeding when used for anticoagulation during PCI in patients with acute coronary syndromes and is not associated with an increased risk of stent thrombosis or major adverse cardiovascular event.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Modern review comparing bivalirudin vs heparin in ACS PCI through the BRIGHT-4 era, with practical algorithm for selection by bleeding risk and dosing strategy.
Por qué esto importa para la hirudoterapia
Esta revisión sistemática y metaanálisis comparó la heparina no fraccionada con la bivalirudina para la anticoagulación durante la intervención coronaria percutánea en síndromes coronarios agudos, agrupando datos de 10 ensayos prospectivos que incluyeron a 42 253 pacientes. La heparina se asoció con riesgos significativamente mayores de hemorragia mayor, complicaciones en sitios distintos al de acceso, muerte cardiovascular y trombocitopenia en comparación con la bivalirudina, mientras que no se encontraron diferencias significativas en la mortalidad por todas las causas, la trombosis del stent ni los eventos cardiovasculares adversos mayores. El resumen no aborda las sanguijuelas, el origen de la hirudina ni la hirudoterapia, por lo que no puede establecerse un vínculo defendible con el ámbito de ASH a partir únicamente de este artículo. Los hallazgos corresponden a la anticoagulación farmacológica en cardiología intervencionista y no son aplicables directamente a la terapia tradicional con sanguijuelas.
Citación
Bivalirudin versus heparin in patients undergoing percutaneous coronary intervention in acute coronary syndromes.
Krittanawong C et al. · Critical pathways in cardiology, 2025
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026